Common Grant Application

COME TOGETHER FERGUSON GRANT APPLICATION The Come Together Ferguson Fund is seeking applications from nonprofit organizations operating within the City of Ferguson and its adjacent municipalities.

The Fund Advisors are looking for organizations that are working with youth ages 5 – 24 that are providing summer enrichment services. These programs can include; day camps, ministry programs, school based education enrichment programs, life and job skill programs to prepare young people for summer employment opportunities and any other program that is designed to meet the immediate needs of young people in the community for which summer funding would still be helpful.

The grants are small in nature and are designed to be supplemental grants for programs that need funding for increased capacity during the summer. Grant allocations will be between $2,000 and $5000 depending upon the unmet need.

Come Together Ferguson is stewarded by a group of community leaders including, residents, clergy, classroom teachers, law enforcement officers, business owners and other stakeholders in the Ferguson community and is a component fund of The Greater Saint Louis Community Foundation.

Instructions: 1. Please complete and enclose the following:

 Application

 All Required attachments listed on the last page

2. Attend an informational session about The Common Grant Application

Friday, May 15th 12:00 – 1:30 pm St. Stephen’s & The Vine Church 33 N. Clay, Ferguson MO 63135 rsvp [email protected]

3. Submit proposals by May 22, 2015

4. Please answer all the questions.

5. Please type your answers or write legibly.

6. Please do not include any materials other than those specifically requested.

7. Contact [email protected] with any questions concerns.

Submit your application by mail or email: Come Together Ferguson c/o Greater Saint Louis Community Foundation 319 North Fourth Street, Suite 300 Saint Louis, MO 63102 [email protected]

Additional Grant Seeking and Writing Resources:  St. Louis Public Library’s Grants and Foundation Center-http://previous.slpl.org/using/foundation.htm  Foundation Center resources can also be accessed at the Kirkwood Public Library and the St. Charles Public Library.  Foundation Center Guide to Proposal Writing- http://foundationcenter.org/getstarted/tutorials/shortcourse/components.html

Visit the User Guide for the following information:  Common Grant Application background.  Frequently Asked Questions.  Glossary of terms.  Guide to each question asked in this application including examples on how to best answer each question.

Missouri CGA: Page 2 of 7 Common Grant Application Cover Sheet Grantmaker to whom this application is COME TOGETHER FERGUSON FUND submitted: Org Application Date: Website: Organization’s Legal Name: (as shown on IRS Letter of Determination) Doing Business As: (if different from legal name) EIN #: Address:

City: State: Zip code:

Telephone #: Fax #:

Executive Director: Phone #: (or Top Executive) (Please include prefix and title) Email Address: Main Contact(s) for Phone #: this Proposal: (Please include prefix and title) Email Address: Phone #: Board President: Email Address:

Applicant’s tax exempt status/ IRS designation (e.g. 501(c) (Attach a copy of the IRS Letter of Determination- NOTE- this is not the state sales and use tax exemption certificate. If there has (3) been a name change provide copies of the amended state certificate of incorporation and amended IRS Letter of Determination)

If not a 501(c)(3) Nonprofit, then who is fiscal agent? (Attach a copy of the written agreement from fiscal agent plus fiscal agent’s contact information and EIN)

Organization’s mission statement:

Project Name: (if general operating please indicate)

Missouri CGA: Page 3 of 7 Proposal Summary - In 100 words or less summarize the purpose of this request.

Funding Period Requested: / / through / / $ Amount Requested: (be specific) Total Project Budget for this $ Current Annual $ period: (not required if general Organizational Budget: operating request) / / through / / Organization Fiscal Year:

Geographic Area(s) Served: (include specific counties, cities, municipalities) (For this project. If general operations support, for this organization.)

List applicant’s membership of a giving federation: (e.g., United Way, Arts & Education Council, Jewish Federation)

Agreement I certify to the best of my knowledge, that all information included in this proposal is correct. The tax exempt status of this organization is still in effect. If a grant is awarded to this organization, then the proceeds of that grant will not be distributed or used to benefit any organization or individual supporting or engaged in unlawful activities.

In compliance with the USA Patriot Act and other counterterrorism laws, I certify that all funds received from this funder will be used in compliance with all applicable anti-terrorist financing and asset control laws, statutes, and executive orders.

Signature, Executive Director Date (or authorizing official on behalf of the organization)

Missouri CGA: Page 4 of 7 NARRATIVE

SECTION A: ORGANIZATIONAL INFORMATION 1. Summary of organization’s history.

2. Description of the organization’s current programs, activities, number served annually, and accomplishments.

SECTION B: NEEDS STATEMENT 3. What are the community needs or problems to be addressed by this project?

SECTION C: PROJECT INFORMATION Please check: New Program Existing Program Expanding Program 4. Who will be served by this grant (describe) and how many will be served?

5. What are your project goals?

6. What activities do you intend to engage in or provide to achieve these goals? Please provide an in-depth description of the activities/services, including 1) how much, 2) how often, 3) how long activities/services will be provided. For expanded project requests, distinguish between current and expanded activities/services.

7. What are the anticipated measurable outcomes that would be achieved by this grant?

8. What is the timeline for implementation of this grant?

Missouri CGA: Page 5 of 7 9. What organizations do you partner and collaborate with to achieve your program outcomes?

10. What other agencies or projects are doing similar work and how are you different?

12. How does this request fit with your organization’s long-term goals? We define long-term as the time-period beyond this grant.

13. Do you plan to continue this program now or in the future? In what way?

SECTION D: EVALUATION 15. What is your evaluation process? How do you plan to track and measure the effectiveness of your project (e.g., intake sheets, participation checklists, pre/post surveys, client questionnaires, follow-up surveys, etc)?

16. How will the evaluation results be used to inform future programming?

REQUIRED ATTACHMENTS 1. A copy of the current IRS Letter of Determination indicating tax-exempt status.

2. List of current board of directors including their professional affiliations (name of organization of employment).

3. Financials  Project Budget (must use excel template included as part of this application)  Organizational Budget (prepared by you, no template provided) AND i. Organization’s most recently filed Form 990 (If you don’t have a 990 please explain why) ______. Must include: * statement of activities (income statement) * statement of financial position (balance sheet) * statement of cash flow NOTE- financial statements are to be prepared according to generally accepted accounting procedures (GAAP)

Missouri CGA: Page 6 of 7 Missouri CGA: Page 7 of 7